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Paul P, Bennett CN. Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention. Clin EEG Neurosci 2021; 52:321-329. [PMID: 33709806 DOI: 10.1177/1550059421997129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.
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Boland C, Jalihal V, Organ C, Oak K, McLean B, Laugharne R, Woldman W, Beck R, Shankar R. EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review. Clin EEG Neurosci 2021; 52:254-273. [PMID: 32635758 DOI: 10.1177/1550059420937948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.
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Affiliation(s)
- Cailín Boland
- Saint James's Hospital, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
| | | | | | - Katy Oak
- 8028Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Richard Laugharne
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| | | | - Randy Beck
- Institute of Functional Neuroscience, Perth, Western Australia, Australia
| | - Rohit Shankar
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
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Wigton NL, Krigbaum G. Attention, Executive Function, Behavior, and Electrocortical Function, Significantly Improved With 19-Channel Z-Score Neurofeedback in a Clinical Setting: A Pilot Study. J Atten Disord 2019; 23:398-408. [PMID: 25823743 DOI: 10.1177/1087054715577135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neurofeedback (NF) is gaining recognition as an evidence-based intervention grounded in learning theory, and 19-channel z-score NF (19ZNF) is a new NF model. This pilot study sought to evaluate the efficacy of 19ZNF in a clinical setting. METHOD Outcome measures framed groups such that 19ZNF was evaluated, as it relates to the neuropsychological constructs of attention ( n = 10), executive function ( n = 12), behavior ( n = 14), and electrocortical functioning ( n = 21). One-tailed t tests compared pre-post difference scores. RESULTS For all pre-post comparisons, the direction of change was in the predicted direction, and differences were statistically significant ( p = .000 to p = .008, effect sizes 1.29 to 3.42). CONCLUSION Results suggest 19ZNF improved attention, executive function, behavior, and electrocortical function. This study provides beginning evidence of 19ZNF's efficacy, adds to what is known about 19ZNF, and offers an innovative approach for using quantitative electroencephalographic (QEEG) metrics as outcome measures.
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Affiliation(s)
- Nancy L Wigton
- 1 Grand Canyon University, Phoenix, AZ, USA.,2 Applied Neurotherapy Center, Scottsdale, AZ, USA
| | - Genomary Krigbaum
- 1 Grand Canyon University, Phoenix, AZ, USA.,3 Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
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Güntensperger D, Thüring C, Meyer M, Neff P, Kleinjung T. Neurofeedback for Tinnitus Treatment - Review and Current Concepts. Front Aging Neurosci 2017; 9:386. [PMID: 29249959 PMCID: PMC5717031 DOI: 10.3389/fnagi.2017.00386] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/09/2017] [Indexed: 12/18/2022] Open
Abstract
An effective treatment to completely alleviate chronic tinnitus symptoms has not yet been discovered. However, recent developments suggest that neurofeedback (NFB), a method already popular in the treatment of other psychological and neurological disorders, may provide a suitable alternative. NFB is a non-invasive method generally based on electrophysiological recordings and visualizing of certain aspects of brain activity as positive or negative feedback that enables patients to voluntarily control their brain activity and thus triggers them to unlearn typical neural activity patterns related to tinnitus. The purpose of this review is to summarize and discuss previous findings of neurofeedback treatment studies in the field of chronic tinnitus. In doing so, also an overview about the underlying theories of tinnitus emergence is presented and results of resting-state EEG and MEG studies summarized and critically discussed. To date, neurofeedback as well as electrophysiological tinnitus studies lack general guidelines that are crucial to produce more comparable and consistent results. Even though neurofeedback has already shown promising results for chronic tinnitus treatment, further research is needed in order to develop more sophisticated protocols that are able to tackle the individual needs of tinnitus patients more specifically.
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Affiliation(s)
- Dominik Güntensperger
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Christian Thüring
- Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland
| | - Martin Meyer
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Patrick Neff
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland
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Dalkner N, Unterrainer HF, Wood G, Skliris D, Holasek SJ, Gruzelier JH, Neuper C. Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder. Front Psychol 2017; 8:1688. [PMID: 29018397 PMCID: PMC5622970 DOI: 10.3389/fpsyg.2017.01688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/13/2017] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the effects of alpha/theta neurofeedback on Clinical Personality Accentuations in individuals with alcohol use disorder. Twenty-five males were investigated using a pre-test/post-test design with a waiting-list control group. Participants were randomly assigned either to an experimental group (n = 13) receiving 12 sessions of neurofeedback twice a week as a treatment adjunct over a period of 6 weeks, or to a control group (n = 12) receiving treatment as usual. The Inventory of Clinical Personality Accentuations and the NEO-Five-Factor Inventory were applied at pre- and post-test. The neurofeedback protocol focused on enhancement of the EEG alpha (8-12 Hz) and theta (4-7 Hz) and used a visual feedback paradigm. Analyses of covariance showed improvements in Avoidant Personality Accentuation within the experimental group. Our data suggest that 12 sessions of this neurofeedback intervention might be effective in reducing avoidant and stress-related personality traits in patients with alcohol use disorder.
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Affiliation(s)
- Nina Dalkner
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria.,Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Human F Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.,Center for Integrative Addiction Research (Grüner Kreis Society), Vienna, Austria
| | - Guilherme Wood
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
| | - Dimitris Skliris
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
| | - Sandra J Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - John H Gruzelier
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Christa Neuper
- Institute of Psychology, Karl-Franzens University of Graz, Graz, Austria
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Lackner N, Unterrainer HF, Skliris D, Shaheen S, Dunitz-Scheer M, Wood G, Scheer PJZ, Wallner-Liebmann SJ, Neuper C. EEG neurofeedback effects in the treatment of adolescent anorexia nervosa. Eat Disord 2016; 24:354-74. [PMID: 27027700 DOI: 10.1080/10640266.2016.1160705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A pre-post design including 22 females was used to evaluate the effectiveness of neurofeedback in the treatment of adolescent anorexia nervosa. Resting EEG measures and a psychological test-battery assessing eating behavior traits, clinical symptoms, emotionality, and mood were obtained. While both the experimental (n = 10) and control group (n = 12) received their usual maintenance treatment, the experimental group received 10 sessions of individual alpha frequency training over a period of 5 weeks as additional treatment. Significant training effects were shown in eating behavior traits, emotion regulation, and in relative theta power in the eyes closed condition. Although the results are limited due to the small sample size, these are the first empirical data demonstrating the benefits of neurofeedback as a treatment adjunct in individuals with anorexia nervosa.
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Affiliation(s)
- Nina Lackner
- a Department of Neuropsychology , Karl-Franzens University Graz , Graz , Austria.,b Department of Psychiatry , Medical University Graz , Graz , Austria
| | - Human-Friedrich Unterrainer
- b Department of Psychiatry , Medical University Graz , Graz , Austria.,c Center for Integrative Addiction Research (CIAR), Grüner Kreis Society , Vienna , Austria
| | - Dimitris Skliris
- a Department of Neuropsychology , Karl-Franzens University Graz , Graz , Austria
| | - Sandra Shaheen
- d Department of Psychiatry , Harvard University Medical School , Boston , Massachusetts , USA
| | - Marguerite Dunitz-Scheer
- e Psychosomatic & Psychotherapeutic Unit, Department for General Pediatrics , Medical University Graz , Graz , Austria
| | - Guilherme Wood
- a Department of Neuropsychology , Karl-Franzens University Graz , Graz , Austria
| | - Peter Jaron Zwi Scheer
- e Psychosomatic & Psychotherapeutic Unit, Department for General Pediatrics , Medical University Graz , Graz , Austria
| | | | - Christa Neuper
- a Department of Neuropsychology , Karl-Franzens University Graz , Graz , Austria
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Krigbaum G, Wigton NL. A Methodology of Analysis for Monitoring Treatment Progression with 19-Channel Z-Score Neurofeedback (19ZNF) in a Single-Subject Design. Appl Psychophysiol Biofeedback 2016; 40:139-49. [PMID: 25777656 DOI: 10.1007/s10484-015-9274-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
19-Channel Z-Score Neurofeedback (19ZNF) is a modality using 19-electrodes with real-time normative database z-scores, suggesting effective clinical outcomes in fewer sessions than traditional neurofeedback. Thus, monitoring treatment progression and clinical outcome is necessary. The area of focus in this study was a methodology of quantitative analysis for monitoring treatment progression and clinical outcome with 19ZNF. This methodology is noted as the Sites-of-Interest, which included repeated measures analyses of variance (rANOVA) and t-tests for z-scores; it was conducted on 10 cases in a single subject design. To avoid selection bias, the 10 sample cases were randomly selected from a pool of 17 cases that met the inclusion criteria. Available client outcome measures (including self-report) are briefly discussed. The results showed 90% of the pre-post comparisons moved in the targeted direction (z = 0) and of those, 96% (80% Bonferroni corrected) of the t-tests and 96% (91% Bonferroni corrected) of the rANOVAs were statistically significant; thus indicating a progression towards the mean in 15 or fewer 19ZNF sessions. All cases showed and reported improvement in all outcome measures (including quantitative electroencephalography assessment) at case termination.
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Affiliation(s)
- Genomary Krigbaum
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Road, Indianapolis, IN, 46222-1997, USA,
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Focquaert F. Mandatory neurotechnological treatment: ethical issues. THEORETICAL MEDICINE AND BIOETHICS 2014; 35:59-72. [PMID: 24407528 DOI: 10.1007/s11017-014-9276-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
What if neurofeedback or other types of neurotechnological treatment, by itself or in combination with behavioral treatment, could achieve a successful "rewiring" of the psychopath's brain? Imagine that such treatments exist and that they provide a better long-term risk-minimizing strategy compared to imprisonment. Would it be ethical to offer such treatments as a condition of probation, parole, or (early) prison release? In this paper, I argue that it can be ethical to offer effective, non-invasive neurotechnological treatments to offenders as a condition of probation, parole, or (early) prison release provided that: (1) the status quo is in no way cruel, inhuman, degrading, or in some other way wrong, (2) the treatment option is in no way cruel, inhuman, degrading, or in some other way wrong, (3) the treatment is in the best interests of the offender, and (4) the offender gives his/her informed consent.
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Affiliation(s)
- Farah Focquaert
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium,
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Surmeli T, Ertem A, Eralp E, Kos IH. Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series. Clin EEG Neurosci 2012; 43:133-44. [PMID: 22715481 DOI: 10.1177/1550059411429531] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schizophrenia is sometimes considered one of the most devastating of mental illnesses because its onset is early in a patient's life and its symptoms can be destructive to the patient, the family, and friends. Schizophrenia affects 1 in 100 people at some point during their lives, and while there is no cure, it is treatable with antipsychotic medications. According to the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE), about 74% of the patients who have discontinued the first medication prescribed within a year will have a relapse afterward. This shows an enormous need for developing better treatment methods and better ways to manage the disease, since current therapies do not have sufficient impact on negative symptoms, cognitive dysfunction, and compliance to treatment. In this clinical case series, we investigate the efficacy of quantitative electroencephalography (qEEG)-guided neurofeedback (NF) treatment in this population, and whether this method has an effect on concurrent medical treatment and on the patients. Fifty-one participants (25 males and 26 females) ranging from 17 to 54 years of age (mean: 28.82 years and SD: 7.94 years) were included. Signed consent was received from all patients. Most of the participants were previously diagnosed with chronic schizophrenia, and their symptoms did not improve with medication. All 51 patients were evaluated using qEEG, which was recorded at baseline and following treatment. Before recording the qEEG, participants were washed out for up to 7 half-lives of the medication. After Food and Drug Administration (FDA)-approved Nx-Link Neurometric analysis, qEEGs suggested a diagnosis of chronic schizophrenia for all participants. This was consistent with the clinical judgment of the authors. The participants' symptoms were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Besides the PANSS, 33 out of 51 participants were also evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) and the Test of Variables of Attention (TOVA), both at baseline and following treatment. Each participant was prescribed an NF treatment protocol based on the results of their qEEG neurometric analysis. Each session was 60 minutes in duration, with 1 to 2 sessions per day. When 2 sessions were administered during a single day, a 30-minute rest was given between the sessions. Changes in the PANSS, MMPI, and TOVA were analyzed to evaluate the effectiveness of NF treatment. The mean number of sessions completed by the participants was 58.5 sessions within 24 to 91 days. Three dropped out of treatment between 30 and 40 sessions of NF, and one did not show any response. Of the remaining 48 participants 47 showed clinical improvement after NF treatment, based on changes in their PANSS scores. The participants who were able to take the MMPI and the TOVA showed significant improvements in these measures as well. Forty were followed up for more than 22 months, 2 for 1 year, 1 for 9 months, and 3 for between 1 and 3 months after completion of NF. Overall NF was shown to be effective. This study provides the first evidence for positive effects of NF in schizophrenia.
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Affiliation(s)
- Tanju Surmeli
- Living Health Center for Research and Education, Istanbul, Turkey.
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The Asilomar Survey: Stakeholders' Opinions on Ethical Issues Related to Brain-Computer Interfacing. NEUROETHICS-NETH 2011; 6:541-578. [PMID: 24273623 PMCID: PMC3825606 DOI: 10.1007/s12152-011-9132-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 07/28/2011] [Indexed: 10/29/2022]
Abstract
Brain-Computer Interface (BCI) research and (future) applications raise important ethical issues that need to be addressed to promote societal acceptance and adequate policies. Here we report on a survey we conducted among 145 BCI researchers at the 4th International BCI conference, which took place in May-June 2010 in Asilomar, California. We assessed respondents' opinions about a number of topics. First, we investigated preferences for terminology and definitions relating to BCIs. Second, we assessed respondents' expectations on the marketability of different BCI applications (BCIs for healthy people, BCIs for assistive technology, BCIs-controlled neuroprostheses and BCIs as therapy tools). Third, we investigated opinions about ethical issues related to BCI research for the development of assistive technology: informed consent process with locked-in patients, risk-benefit analyses, team responsibility, consequences of BCI on patients' and families' lives, liability and personal identity and interaction with the media. Finally, we asked respondents which issues are urgent in BCI research.
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